How Does Medicare Cover Cancer Treatment?

Medicare covers various cancer treatments such as chemotherapy, radiation, surgeries, and associated services. Coverage varies across different Medicare parts, leading to differences in covered treatments and out-of-pocket expenses. Here’s an overview of how Medicare addresses key cancer treatments.

Is chemotherapy covered by Medicare?

Yes, both oral and intravenous chemotherapy are covered. Medicare Part B covers necessary chemotherapy administered at a doctor’s office or outpatient clinic, paying 80% of the approved cost after meeting the deductible, with you responsible for the remaining 20% as coinsurance. Medicare Supplement Insurance or Medigap may cover this coinsurance. Medicare Advantage plans must provide equivalent coverage, including outpatient chemotherapy, but deductible, coinsurance, and copays differ, so consult your plan for precise out-of-pocket costs.

Oral chemotherapy drugs are covered by Medicare Part D, specifically for prescriptions taken by mouth instead of administered at a medical facility. With Original Medicare, you can purchase a standalone Medicare Part D plan for prescription drug coverage. However, if you’re enrolled in a Medicare Advantage plan that includes prescription drug coverage, you cannot obtain a separate Part D plan. Regardless of your coverage type, it’s essential to review your plan’s formulary to understand which drugs are covered and what your associated costs would be.

Does Medicare cover radiation therapy?

Certainly! Medicare covers essential radiation therapy for cancer treatment. If received as an inpatient at a hospital, it falls under Medicare Part A coverage. Following the $1,632 deductible in 2024, there are no copays for the first 60 days of hospitalization. When received at a freestanding clinic or outpatient hospital department, radiation therapy is covered by Medicare Part B, with a 20% coinsurance unless supplemented by a Medigap policy. Medicare Advantage also covers necessary radiation therapy; however, specifics regarding provider networks and costs vary by plan, necessitating consultation for accurate details.

Does Medicare cover cancer surgery?

Yes! Medicare provides coverage for essential cancer surgeries deemed medically necessary. When conducted as an inpatient procedure at a hospital, Medicare Part A covers both the surgery itself and the associated hospital stay, with no copays for the initial 60 days following the deductible in 2024. If the surgery occurs as an outpatient procedure, whether at a hospital, clinic, or ambulatory surgical center, Medicare Part B provides coverage. In such cases, you would typically owe 20% of Medicare’s approved amount for the procedure, though this coinsurance can be mitigated with a Medigap policy. Medicare Advantage plans are mandated to offer at least the same benefits as Medicare Part A and Part B, thus encompassing medically necessary inpatient or outpatient cancer surgeries. However, costs and provider networks can vary among plans, necessitating a thorough review of your specific plan for precise details.

Does Medicare cover other cancer treatment services?